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NPI Code Detail

MEDICARE: MR. JEJERRY STALLER

MEDICARE: MR. JEJERRY STALLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist002976NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122OTHERNY002976

General Provider Information

NPI Number : 1255473963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEJERRY STALLER
Provider Business Mailing Address
First Line : 47 HERITAGE DR APT E
Second Line :
City : NEW CITY
State : NY
Zip : 10956-5345
Country : US
Telephone Number : 845-638-0655
Fax Number :
Provider Business Practice Location Address
First Line : 260 N LITTLE TOR RD
Second Line :
City : NEW CITY
State : NY
Zip : 10956-2627
Country : US
Telephone Number : 845-634-4648
Fax Number : 845-643-7731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 12/07/2025

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